Transcript YOUTH WHO ARE ANGRY AND DEPRESSED

WRAPAROUND MILWAUKEE
“Never doubt that a small group
of committed citizens can
change the world: indeed, it’s
the only thing that ever does.”
Margaret Mead
Presented by:
Bruce Kamradt
Project Director
Operated by
Milwaukee County Mental Health Division
Child & Adolescent Services Branch
What Has Been Achieved In
Wraparound Milwaukee for
Children with Severe Emotional Needs
 Better Clinical Outcomes

Children & Families Function Better
 Reduced Recidivism of Delinquent Youth
Served
 Improved School Attendance
 Reduction in the Use of Residential Treatment
& Psychiatric Hospitalization
 Reduction in Cost of Care
Wraparound Approach for Children with
Serious & Complex Mental Health Needs
 Focus on Family and Children’s Strengths
 One Family - One Plan Across Systems
 Community-Based Care and Treatment
 Needs Driven vs Categorical Services
 Care for Children in Context of Families
 Parent Choice in Provision of Services
 Focus on Refinancing Strategies
 Unconditional Care
What is Wraparound Milwaukee
 Public Care Management Organization
 Governance with Milwaukee County Behavioral Health
Division
 Manages the Care of Children with Serious Emotional &
Mental Health Needs at Immediate Risk of Residential
Treatment, Correctional Placement or Psychiatric
Hospitalization
 All referrals come through the Child Welfare or Juvenile
Justice System
 Pools $30 Million in Funds from


Child Welfare
Mental Health
 Medicaid
 Juvenile Justice
Key Components of Program
 Fiscal & Operational Management
 24 Hour Mobile Crisis Team
 Care Coordination
 Provider Network
 80 Services
 230 Agency and Individual Providers
 Family Advocacy / Support Organization
 Quality assurance / Program Evaluation
 Clinical Support and Resource Teams
 Extensive Use of Informal Supports
ie. Boys & Girls Clubs, Churches, Civic Organizations, etc.
Demographics of Children &
Families We Serve
 70% Male  30 % Female
 Average Ave - 13.5 years
 Ethnicity
 64% African American
 27% Caucasian
 7% Hispanic

2% Other
 52% Delinquent - 48% Child Welfare
 50% with Annual Family Income Under $15,000
 40% Regular Education - No IEP
Continued
Demographics of Children &
Families We Serve
 Diagnosis






65%
50%
46%
25%
15%
12%
Conduct Disorder
Depression / Oppositional Defiant
Attention Deficit
Substance Abuse
Adjustment Disorders
Cognitive / Developmental Disorders
What are Pooled Funds?
CHILD WELFARE
JUVENILE JUSTICE
MEDICAID CAPITATION
MENTAL HEALTH
Funds thru Case Rate
(Budget for Institutional
Care for Chips Children)
(Funds Budgeted for
Residential Treatment
for Delinquent Youth)
(1557 per Month per Enrollee)
•CRISIS BILLING
•BLOCK GRANT
•HMO COMMERCIAL INSUR
9.5 M
8.5 M
10 M
WRAPAROUND MILWAUKEE
MANAGEMENT SERVICE ORGANIZATION
(MSO)
30 M
CHILD
AND FAMILY
TEAM
PLAN
OF
CARE
2.0 M
Provider Network
 80 Services
 No Formal Contracting -- services purchased on a fee-




for-service basis -- rates established by Wraparound
Milwaukee
Extensive Quality Assurance/Quality Monitoring
Residential Treatment Vendors were asked to reengineer institutional services to community-based
services
Consumer Choice of Providers
All Providers & Care Managers linked through internetbased IT system for authorizations, plan submission,
invoicing, etc.
Outcomes - Program
 Average
daily Residential Treatment
population reduced from 375 placements to
60 placements
 Psychiatric Inpatient Utilization reduced from
5000 days per year to under 200 days (ave.
LOS of 2.8 days)
 Reduction in Juvenile Correctional
Commitments from 385 per year to 285
Outcomes - Financial
 Wraparound
Milwaukee average monthly
costs is $4350 per child per month versus
$7200 for residential treatment, $6000
monthly for a correctional placement or $600
per day for psychiatric inpatient care
CAREGIVER, CARE COORDINATOR, &
YOUTH REPORTED IMPROVEMENT IN
FUNCTIONING FOR CLIENTS
INSTRUMENT RAW SCORE
80
CBCL
YSR
CAFAS
75
70
65
60
55
50
45
INTAKE
6-MONTH
12-MONTH
Child Behavior Checklist (CBCL), N=219; Youth Self-Report (YSR), N=155; Child &
Adolescent Functional Assessment Scale (CAFAS), N=374. Reductions are significant at
the p<.001 level of significance using a repeated measures analysis of variance.
Year 2001
REDUCTION IN PERCENTAGE OF CLIENTS
REFERRED FOR FELONIES & MISDEMEANORS
WHILE ENROLLED & FOLLOWING DISCHARGE
YEAR PRIOR TO
ENROLLMENT
DURING
ENROLLMENT
FOLLOWING
DISENROLLMENT
PERCENTAGE REFERRED
60%
50%
56%
40%
48%
30%
33%
20%
10%
24%
21%
16%
0%
FELONIES
MISDEMEANORS
N = 490
Year 2001
REDUCTION IN SPECIFIC OFFENSE TYPES
PRIOR TO ENROLLMENT, DURING
ENROLLMENT, AND AFTER DISENROLLMENT
40
PERCENTAGE REFERRED ON OFFENSE
35
YEAR PRIOR TO
ENROLLMENT
39
DURING ENROLLMENT
30
31
YEAR FOLLOWING
DISENROLLMENT
25
20
20
18
15
15
10
18
17
14
11
10
8
5
5
4
0
PROPERTY OFFENSES
OTHER OFFENSES*
ASSAULTS
2
SEX OFFENSES
4
6
3
WEAPONS OFFENSES
6
DRUG OFFENSES
N = 492
*OTHER OFFENSES CONSIST PRIMARILY OF DISORDERLY CONDUCT
Year 2001
Serving Children and Families
with Complex Needs
Operated by
Milwaukee County Behavioral Health Division
Child & Adolescent Services Branch
Operated by
Milwaukee County Behavioral Health Division
Child & Adolescent Services Branch